Ethical and Moral Issues in Ambulance Services EMS
Medicine belongs to one of the most important spheres of human activity. Ambulance workers can save people from the acute illness, medical emergency, and injuries due to the high level of knowledge, professional skills, and abilities. The issue of medical ethics is one of the most important ones in the work of doctors and nurses of ambulance. Modern medical ethics is the doctrine of duties of paramedics in attendance of patients (Klugman, 2007). This discipline is a core issue in the education of medical staff. Every employee of the ambulance service must know and apply this discipline. All medical students study deontology to form their own medical ethics. Clinicians together with the lawyers organize international symposia, congresses, and conferences dedicated to medical ethics. Most clinics have regular classes and workshops about medical ethics for employees. Ethical and moral issues should play the main positive impact on the treatment due to better interaction with the patient and for the formation a qualified health professional, especially a specialist of ambulance service, whose job, without exaggeration, is the salvation of human life.
The Ability to Get on the Right Side of Patient and Gain his Confidence
Work of emergency doctor is permanently linked with the examination and treatment of many patients in a short time. Doctors often have to make decisions on the place of accident. Based on this the most important thing in the work, a doctor is to gain the patient's confidence. Undoubtedly, a doctor should always be calm and polite, and he should avoid arrogance and haste. The patient, in turn, trusts the doctor if he believes in his sincerity, good faith, if he is convinced of the competence and expertise. It works if he feels that the physician understands and tries to help him (French & Casali, 2008).
Emergency doctors also need to be very careful when they formulate the report to the responsible physician or physician on call, especially if he does it, when the patient and his relatives are near. The calmness of the voice and dialogue with open questions will make the impression of professionalism and concernment of doctor in the problem. Emergency doctor must never fall into despair, even in the most adverse conditions. Based on professional training he must always take a hold on himself and find the right way out of the most difficult circumstances.
Confidence of the patient allows the doctor to get from the patient and from his relatives more information or special details of the problem with health. As a result, gained patient’s confidence gives the doctor an opportunity to take a more objective solution for solving the problem.
Attention to a Patient
During his visit to a patient, an emergency doctor must not show that he does not have enough time, has some other challenges, and he is in a hurry. It usually makes a very bad impression. Conversation of doctor with the patient should proceed without any haste, in an atmosphere of goodwill. The initiator must be a physician who chooses desired direction of conversation. Straight conversation gives opportunity to share his problem with doctor.
The conversation should be conducted in a language which patient will understand, and correspond to the level of his knowledge, using understandable terms or their substitutes. The doctor should always carefully monitor the progress of the conversation, try to make the patient to some extent an assistant. This role of patient helps to clarify the diagnosis and to make successful aid (Steer, 2012).
If any doctor of ambulance comes to the place of call, assesses the situation and realizes that call was not necessary, he understand that somebody is waiting for him, but he comes to the patient who does not need emergency assistance. It provokes a great mind to tell patient about it. That is unacceptable under any circumstances. In fact, after such comments from the doctor, one cannot speak about any contact with the patient as well as the efficiency of health care since the patient's condition caused by stressful situation can only deteriorate. Very often, such situations occur in relation to chronic diseases (primarily socially disadvantaged people: lonely, elderly, and disabled).
At the same time, someone should not forget that this group of patients with 40% frequently requires more attention and interest from the medical services. The ability to make contact with the patient is the art of aerobatics of any paramedic SMP that it cannot be taught from textbooks. It is produced by years of hard work on themselves, especially in ethics issues, morals, and ethics; it is possible only to rise. The patient must feel that during the contact with him, nothing is more important for the doctor and his team, and this time is dedicated only for him and that he is the only center of attention for a doctor (Touchstone, 2010).
If a patient understands that the doctor, despite all his problems, postpones everything and pays attention to what he is concerned about and what is important to him, it consolidates close to the patient and an open attitude. If the patient still exaggerates the need to call an ambulance, then in such a situation, it causes him regret, because he understands that such attention could be useful to someone else.
Loyalty and Firmness to the Patient's Knowledge about the Disease
The problem of the modern medicine is patient's desire to carry out a self-diagnosis based on the knowledge obtained from unconfirmed sources. Emergency doctors should be aware of that now since it is connected with the growth of general culture and education of the population. A patient cannot draw objective conclusions from the information, because of the specific area of medicine that requires education. In an interview with such patients, a doctor needs to be especially sensitive and patient. Before them, an emergency room physician acts as the plenipotentiary of the medicine and patiently convinces them of the correctness of the diagnosis and the need for the prescribed treatment. The main thing is not to be categorical in his judgments about the knowledge the patient, even if it is obviously wrong. The doctor should take it as a challenge of the present and show loyalty to the patient.
A conversation with the emergency doctor with hypochondriac patients who have already presupposed presence of severe and incurable disease should have quite a different character. A doctor should always speak with such patients about their illness with a certain degree of optimism. If possible, it is necessary to inform such a person accurately about the diagnosis of the illness, in simple terms to reveal the essence of the disease and, thus to try to bring him to actively participate in the treatment. If the patient already knows about his serious illness, it is not necessary to debate with him. Any inaccuracy in the words of the doctor may be estimated by the patient as unqualified behavior (Accreditation Canada, 2014).
At the same time, someone should not justify those patients who, after reading non-fiction, show skepticism, which is very difficult for building relationships. The behavior of such patients towards the doctor often can be in the form of rudeness. In such cases, the doctor must show strong hardness and solidity. He must be able to rebuff any display of arrogance and contempt by patients, as this rudeness can intervene the confidence of patient in doctor’s knowledge and as a result the process of treatment. The physician should be stern but should not have a negative attitude to the patient. Confidence in the experience and calm reasoning is ability to convince the majority of these patients, it also confirms the authority of the doctor. Thus, knowledge of the patients about their health problems should not scare or, even more, irritate the doctor. Restraint and loyalty will transfer the patient from the role of the opponent to the role of collaborator, which will promote issue solving.
Ethics Regarding the Team Members and Other Physicians
Important goals of medical ethics ambulance are to create a team spirit inside and to avoid criticism of the previous doctors or treatment plans. Emergency doctor is obliged to pay constant attention to the relationship between the members of the ambulance. Between the team members good friendly relationships should be, that are built on mutual respect and maintaining the authority of each other, comradely mutual assistance. These relationships define a healthy psychological climate in the team and maintain a good cheerful mood for all its members. Emergency doctors should understand that especially intolerable thing is arrogant and contemptuous attitude of the head of the brigade to the younger and middle medical personnel. The observance of ethical relationship of the doctor and the nurses directly in the presence of the patient is also important. Moreover, often, the patient is not alone and there are still relatives or friends with him (Iserson, 1991). For all present individuals, employees of the ambulance should look as a professional coordinated team.
Similarly, the art of aerobatics is the ability to competently complete the challenge, to inform the patient, relatives, or others about effectiveness of medical care, give recommendations to provide the patient and the relatives with a clear understanding of the problem. Teamwork, where each member knows what he has to do, and the rest who support each other, creates a sense of professionalism. The patient begins to trust the employee ambulance. In addition, the relatives of the patient can share valuable information with other team members.
Emergency doctor, who correctly, properly, in compliance with all laws of honor, morality and medical ethics bases its work and relationships with colleagues, middle and junior medical staff, patients and relatives, and complies with all the basic principles and rules of medical ethics, as a rule, operates easily. If an unfavorable outcome results the treatment of critically ill, but the doctor followed all the rules of ethics, the relatives of the deceased often advocates such a doctor and help him. In contrast, non-compliance of ethical rules between the patient and family and the doctor may push conflicts even in the case of correct treatment and recovery of the patient.
It is known that one of the first duties of a doctor is to maintain the credibility of their colleague. It is unacceptable to give negative comments about previous treatment and the previous doctor, inaccurate diagnosis or rebuttal. The doctor fast in action should be careful in judgment, and in any case not be hasty in his reasoning and conclusions. Without any exception, he must abide by all the rules of ethics in a conversation with the patient and during his examination. Educated, skilled, knowledgeable doctor of ambulance never allows himself to break such rules. It is the duty of every doctor to take reasonable tolerance for the opinion of his colleagues. Attempts to create a reputation for belittling the authority of another doctor never crowned with success (Steer, 2012).
The doctor, who works with a patient in the hospital, certainly has plenty of time for diagnosis and decision-making. In an emergency room, a physician often has little time to spare, cannot objectively diagnose and, even more so, comment the early diagnosis and the doctor's decision in the presence of the patient. Patients with long-term problems may also have information about their cases, and may notice a biased emergency doctor. This behavior can cause not only trust and doubt in qualifying emergency doctor.
Thus, emergency physician must respect the members of his team to generate team spirit. A well-coordinated team always works quickly and efficiently, and it creates a positive impression of the patient. In addition, the physician must refrain from comments on the work of his colleagues, in any case do not give away their criticism. This behavior does not cause the respect of the patient, but rather a lack of confidence, which may hinder the process of care.
One of the important elements of medical ethics is to maintain patient confidentiality. Graduating from the medical school, any doctor takes an oath as he vows to keep the medical secret always. Patients should be confirmed by a guarantee of confidentiality of information transmitted to them. Only with patient’s agreement or with his legal representative’s one, it is permitted to reveal information constituting a medical secret. Especially carefully and punctually, this vow must be complied by a doctor of ambulance. By the nature of his activities, he has to talk not only with patients but also with their relatives, people close to them, and neighbors. In conversations with the latest emergency doctors should be very careful, as even the closest relatives cannot always be informed in detail on the state of health of the patient, who had just been inspected. Notification of friends and family of the patient about his health when it is not needed or when it is associated with preservation of medical confidentiality, is the way to the violation of medical secrecy (American Heart Association, 2000).
One sample situation, which relates to ethics, should be presented. An example of this can be a case that happened in France. The nurse told a wife about her husband's venereal disease, which led to divorce. In turn, he filed a lawsuit against the doctor and the clinic for the dissemination of information. This information should have been saved as medical confidentiality by the nurse, and the wife should got it only from her husband (Ebrahimian, Seyedin, Jamshidi-Orak & Masoumi, 2014). It can be seen, that the situation contains law violation as medical secrecy is prescribed by law in France. Therefore, there are several steps of sample policy to modify behavior of the staff.
First, in France, in accordance with the law, the doctor is obliged to keep medical secrecy not only before individuals, but also institutions, even in those cases, if the patient became aware of the preparation or commission of a serious criminal offense.
In this case, the head of the clinic should be on the side of the law and the patient:
- The manager should dismiss the nurse who had revealed a medical secret.
- Organize a meeting with all employees of the clinic and make a lecture on patient confidentiality together with lawyers.
- Systematically hold meetings for the staff of hospitals regarding medical ethics and report about known examples of its violation.
- Notify about this case all new staff, hiring them.
These steps of staff policy would correct the problem with the staff behavior, which was presented.
It is necessary to educate all members of the ambulance brigade in the spirit of meticulous attitude to the preservation of medical confidentiality. An emergency doctor should periodically remind the members of his team that the professional conversations after examination of the patient, in any case should not be carried out in places where there is never a certainty that they cannot be accidentally or intentionally heard by unauthorized persons. The state of health of the patient should be told him or his nearest relatives in very tactful and concise manner without unnecessary details in the absence of other persons. Ambulance workers cannot distribute either medical or personal information, which they get in the course of care. They should not answer the questions of strangers.
Thus, medical confidentiality is regulated by both the law and the conscience of the doctor and his team. Caution in the comments and medical secrecy keeping affects the reputation of the doctor and can protect it from collision with the patient and his family.
Provision of SMP on the Street
On the street, separate behavior and action of a more decisive nature aimed at providing assistance are required from ambulance. In these cases, the doctor should be objectively strict and decisive. His aides’ orders should be respected; they should be given quick and resolute tone. Bustle and nervousness should not be shown. Very often, a group of people who try to participate in the discussion can affect the person after the accident. Most of these people will to give advice or to join the process of care without realizing what is happening with the individual who requires medical attention. With such people, it is better not to enter into a dispute, but doctors should not allow them to approach the patient. It must be remembered that at the sight of the blood, some people behave inappropriately. The doctor must remember that a victim is the priority for him and his team, any controversy only takes away his valuable time (National Highway Traffic Safety Administration, 2009).
Ethical issues become particularly important in case of working in extreme conditions, results of accidents and natural disasters. The discrepancy among the number of victims and the possibility of providing emergency aid, changing objectives, tactics, increasing the rigidity of conditions, including ethical and deontological issues, become foreground. The doctor EMS may have difficulties of a moral choice, the risk borders on moral preferences. In a stressful situation, the team of the emergency doctor should speak with a loud voice; the head of the team should put medical staff in correct places, give commands to the sorting and delivery of health care, and provide communication with the dispatcher from hospital. Tragic and stressful situations caused by the loss of loved ones cause the necessity of psychotherapeutic help, elements of which are humanity, kindness, sensitivity. In such cases, the doctor should not be distracted by extraneous events; he should pay attention to the survivors who need help. Thus, work on the street in case of an accident or natural disaster requires maximizing coherence and mutual support within ambulance teams. The physician should be concentrated, should rely only on his team, should not to be distracted by outsiders and focus only on the victims.
The work of the doctor and ambulance teams takes place in a limited time, and it has issues that require immediate solutions. The ethical and moral issues in such cases are the most important ones. The task of a doctor is to be a good professional, however not to forget about calm, firm and confident behavior with respect to all members of his work team. An important feature, which a doctor should have, is his indulgence to the patient's knowledge about the problem, even if they are not always true. The task of the physician is to inform the patient and gain his confidence. Restraint in the comments on the previous treatment and the preservation of personal information as part of medical secrecy will only call a patient’s respect. Therefore, one must be emphasize that fully implementation of the requirements of medical ethics has a positive effect on the treatment due to better contact between the patient and the doctor, which confirms the thesis.